Central Venous Catheter Placement

Background and indications

Central venous catheter (CVC) placement involves inserting a catheter with its tip in the superior vena cava or right atrium, via the internal jugular, subclavian, or femoral vein. Non-tunneled CVCs are used for short-term central venous access (days to weeks) in hospital settings.

Indications include: administration of venotoxic medications (vasopressors, hyperosmolar parenteral nutrition, urgent chemotherapy), hemodynamic monitoring (CVP, Swan-Ganz), impossible peripheral venous access, and emergency hemodialysis.

Pre-procedure assessment

Venous Doppler (if time permits), coagulation panel, and clinical evaluation. In emergencies, workup may be simplified.

Procedure

Under local anesthesia and ultrasound guidance, the right internal jugular vein (preferred site) is punctured using Seldinger technique. A catheter (7-12 French, single to triple lumen) is advanced and positioned at the cavo-atrial junction. Position verified by fluoroscopy, radiograph, or intracardiac echo. The procedure takes 10 to 20 minutes.

Results and scientific evidence

Ultrasound guidance demonstrated significant complication reduction compared to landmark technique: 64% failure reduction, 72% arterial puncture reduction, and procedure time reduction (Brass et al., Cochrane Database of Systematic Reviews, 2015; DOI: 10.1002/14651858.CD011447). Success rate under ultrasound is 97-100%.

Risks and complications

Arterial puncture (< 2% with ultrasound), pneumothorax (< 1% jugular, 1-3% subclavian), arrhythmia (< 2%), hematoma (< 3%). Late: infection (3-5/1,000 days), venous thrombosis (5-10%).

Recovery

Immediate use. Daily insertion site monitoring. Remove as soon as central access is no longer needed (minimum duration).

Practical information

The procedure is performed during hospitalization (ICU, operating room, or IR suite). Performed by an interventional radiologist, anesthesiologist, or intensivist.